Nivolumab and interferon-γ rescue therapy to control mixed mould and bacterial superinfection after necrotizing fasciitis and septic shock

Abstract

Immunosuppression is a major feature of septic shock and patients are at increased risk for opportunistic infections. We describe a successful use of immunostimulation to treat mixed mould and bacterial superinfection in a previously healthy 38-year-old female patient admitted for severe extensive fasciitis. Interferon gamma associated with nivolumab reversed successfully deactivation of immune cells assessed by altered expressions of monocyte human leukocyte antigen-DR (HLA-DR) and lymphocyte programmed death receptor-1 (PD-1). Immunosuppressed patients in ICU with invasive bacterial and fungal infections may benefit from immunostimulation.

Fig. 1

Clinical presentation of the patient with invasive mucormycosis. (A) Lesions at the body surface. (B) Lesions extending into the chest wall (*: chest tube).

Fig. 2

Chest CT scan showing the extension of the tissue lesion and the pneumothorax.

Fig. 3

The changes of a immunilogical and microbiological parameters under IFN-γ + nivolumab. (A) Serial changes in mHLA-DR under immunotherapy with IFN-γ (daily doses of 100 mcg, orange circles) and one dose of 250 mg nivolumab (anti-PD1 antibody, red triangle) along with results (positive or negative) of tissue and blood cultures or PCR for fungi (Lichtheimia ramosa, Rhizopus arrhizus) over time. (B) Serial changes in PD-1 expression CD4 (blue bars) and CD8 T (red bars) cells (results as % of positive cells) from anti-PD1 antibody administration (red arrow on day 27). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)